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Degenerative joint Disease


Osteoarthritis (OA)
Most common type of arthritis. It is a disease of synovial joints characterized by

Cartilage loss with periarticular bone response.

Three overlapping areas are considered in osteoarthritis :

- Pathological changes (Alteration in cartilage Structure) - Radiological features (Osteophytes and joint space narrowing) - Clinical consequences ( pain and disability)


Common in Age >5o yrs.

Females > males

Occurs world wide.

Clinical Features
Symptoms include:

- gradually developing pain - aggravated or triggered by activity, - stiffness lasting < 30 min on awakening after inactivity, and - occasional joint swelling. Signs - Restriction of jont movement - Tenderness - Crepitus

Primary OA

may be localized usually subdivided by the site of involvement (eg, hands and feet, knee, hip). If involves multiple joints, it is classified as primary generalized OA.

Secondary OA

Results from conditions that change the microenvironment of the cartilage, include

trauma; congenital joint abnormalities; metabolic defects (eg, hemochromatosis, Wilson's disease); infections (causing postinfectious arthritis); endocrine and neuropathic diseases; and disorders that alter the normal structure and function of hyaline cartilage (eg, RA, gout, chondrocalcinosis).

Risk Factors of OA
Obesity, Age, Joint injury, stress on the joints from certain jobs and playing

sports Genetics (Legg-Calve-Perthes disease)

OA is a joint disease that mostly affects cartilage. Cartilage is tissue that covers the bones in a joint. Healthy cartilage allows bones to glide over each

other. It also helps absorb shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away.

OA begins with tissue damage from mechanical injury (eg, torn

meniscus), transmission of inflammatory mediators from the synovium into cartilage, or defects in cartilage metabolism. which increases production of proteoglycans and collagen.

The tissue damage stimulates chondrocytes to attempt repair,

Inflammatory mediators trigger an inflammatory cycle that

further stimulates the chondrocytes and synovial lining cells, eventually breaking down the cartilage. cartilage is destroyed, exposed bone becomes eburnated and sclerotic.

Chondrocytes undergo programmed cell death (apoptosis). Once

The joints most often affected in generalized OA include the following:

Distal interphalangeal (DIP) and proximal

interphalangeal (PIP) joints (causing Heberden's and Bouchard's nodes) Thumb carpometacarpal joint Intervertebral disks and zygapophyseal joints in the cervical and lumbar vertebrae First metatarsophalangeal joint Hip Knee

Erosive OA
Erosive OA

- Causes synovitis and cysts in the hand. - It primarily affects the DIP or PIP joints. - The thumb carpometacarpal joints are involved in 20% of hand OA, but the metacarpophalangeal joints and wrists are usually spared.

X-rays OA should be suspected in patients with gradual

onset of symptoms and signs, particularly in older adults.

X-rays generally reveal marginal osteophytes,

narrowing of the joint space, increased density of the subchondral bone, subchondral cyst formation, bony remodeling, and joint effusions.

Laboratory studies are normal in OA but may be

required to rule out other disorders (eg, RA) or to diagnose an underlying disorder causing secondary OA.

If OA causes joint effusions, synovial fluid analysis

can help differentiate it from inflammatory arthritides; in OA, synovial fluid is usually clear, viscous, and has 2000 WBC/L.

Medical Management Goals

Osteoarthritis treatment has four main goals:

Improve joint function Keep a healthy body weight Control pain Achieve a healthy lifestyle

Medical Management of OA
Conservative treatment

Education Use of heat Weight reduction Joint rest and avoidance of joint overuse Orthotic devices Isometric and aerobic exercises Massage, yoga, Occupational and physical therapy

Medical Management of OA
Alternative therapy

Herbal and dietary supplements Acupuncture, acupressure Copper bracelets or magnets

Pharmacologic Therapy
Symptom management and pain control Medication selection

Patients needs Stage of disease Risk of side effects

Medications and other treatments

Drug therapy is an adjunct to the physical

program. Acetaminophen NSAIDs, including cyclooxygenase-2 (COX-2) inhibitors or coxibs Muscle relaxants (usually in low doses) occasionally relieve pain that arises from muscles strained Oral corticosteroids have no role. However, intra-articular depot corticosteroids help relieve pain and increase joint flexibility.

Synthetic hyaluronans (similar to hyaluronic acid, a

normal component of the joint) can be injected into the knee

Glucosamine sulfate 1500 mg once/day has been

suggested to relieve pain and slow joint deterioration; chondroitin sulfate 1200 mg once/day has also been suggested for pain relief.

Surgical Management
Osteotomy- alter the distribution of weight within

the joint
Arthroplasty- disease joint components are replaced

with artificial products

Tidal irrigation- lavage (provides pain relief for up to

6 months)